Lobotomy is a neurosurgical procedure, a form of
psychosurgeryPsychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...
, also known as a
leukotomy or
leucotomy (from the Greek λευκός –
leukos: "clear/white" and
tome). It consists of cutting the connections to and from the
prefrontal cortexThe prefrontal cortex is the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas.This brain region has been implicated in planning complex cognitive behaviors, personality expression, decision making and moderating correct social behavior...
, the anterior part of the frontal lobes of the brain. While the procedure, initially termed a leucotomy, has been controversial since its inception in 1935, it was a mainstream procedure for more than two decades, prescribed for psychiatric (and occasionally other) conditions—this despite general recognition of frequent and serious side-effects. Half of the Nobel Prize for Physiology or Medicine of 1949 was awarded to António Egas Moniz for the "discovery of the therapeutic value of leucotomy in certain psychoses". The heyday of its usage was from the early 1940s until the mid-1950s when modern neuroleptic (
antipsychoticAn antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
) medications were introduced. By 1951 almost 20,000 lobotomies had been performed in the United States. The decline of the procedure was gradual rather than precipitous. In Ottawa's psychiatric hospitals, for instance, the 153 lobotomies performed in 1953 were reduced to 58 by 1961, after the arrival in Canada of the antipsychotic drug
chlorpromazineChlorpromazine is a typical antipsychotic...
in 1954.
Context
The lobotomy was one of a series of radical and invasive physical therapies developed in
EuropeEurope is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
in the first half of the twentieth century. These psychiatric innovations signaled a break with a culture relegating psychiatric patients to asylums, which had prevailed because most serious forms of mental illness were treated only unsatisfactorily by extreme measure, or as unamenable to treatment. These new early twentieth century physical therapies included malarial therapy for
general paresis of the insaneGeneral paresis, also known as general paralysis of the insane or paralytic dementia, is a neuropsychiatric disorder affecting the brain and central nervous system, caused by syphilis infection...
(1917),
barbiturateBarbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
induced
deep sleep therapyDeep sleep therapy , also called prolonged sleep treatment or continuous narcosis, is a psychiatric treatment based on the use of psychiatric drugs to render patients unconscious for a period of days or weeks.-History:...
(1920),
insulin shock therapyInsulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks...
(1933), cardiazol shock therapy (1934), and
electroconvulsive therapyElectroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
(1938).
The development of the leucotomy procedure by Moniz in 1936, took place at a time when all of the above therapeutic interventions were extreme and experimental forms of therapy and most posed serious risks to the health of the patients who underwent them. Leucotomy was seen by many psychiatrists as no more severe than therapies such as
insulinInsulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
or cardiazol shock; these apparently successful procedures conceived for the treatment of patients suffering severe mental illnesses helped to create the intellectual climate and medical and social warrants that allowed a surgical procedure as radical and irreversible as leucotomy to appear as a viable and even necessary proposition. Moreover, Joel Braslow argues that from malarial therapy onward to lobotomy, physical psychiatric therapies "spiral closer and closer to the interior of the brain" with this organ increasingly taking "centre stage as a source of disease and site of cure." For
Roy PorterRoy Sydney Porter was a British historian noted for his prolific work on the history of medicine.-Life:...
, these often violent and invasive psychiatric interventions are indicative of both the well-intentioned desire of psychiatrists to find some medical means of alleviating the suffering of the thousands of patients in psychiatric hospitals in the twentieth century and also the relative lack of social power of those same patients to resist the increasingly radical and even reckless interventions of asylum doctors.
Gottlieb Burkhardt
It is commonly accepted that the first systematic attempt at human psychosurgery was conducted by the Swiss psychiatrist
Gottlieb BurckhardtJohann Gottlieb Burckhardt was a Swiss psychiatrist and the medical director of small mental hospital in the Swiss canton of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical operation...
in late 1880s. Burckhardt operated on the brains of six patients (one of whom died a few days after the operation) at Préfargier Asylum, cutting out a piece of
cerebral cortexThe cerebral cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It is constituted of up to six horizontal layers, each of which has a different...
. He presented the results at the Berlin Medical Congress and published a report, but the response was hostile and he did no further operations.
Early in the 20th century Russian neurologist
Vladimir BekhterevVladimir Mikhailovich Bekhterev was a Russian Neurologist and the Father of Objective Psychology. He is best known for noting the role of the hippocampus in memory, his study of reflexes, and Bekhterev’s Disease...
and Estonian neurosurgeon
Ludvig PuuseppLudvig Puusepp , was an Estonian surgeon and researcher and the world's first professor of neurosurgery.-Early life:...
operated on three patients with mental illness, with discouraging results.
Egas Moniz
The development of the leucotomy procedure was the work of the Portuguese physician and
neurologistA neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
António Egas Moniz, who was highly acclaimed for his work on cerebral angiography (radiographical visual of the blood vessels in the brain) in 1927. Despite having no clinical psychiatric experience and, indeed, little interest in psychiatry, in 1935 at the Hospital Santa Marta in Lisbon, he devised the surgery called prefrontal leucotomy which was carried out under his direction by the neurosurgeon Pedro Almeida Lima. He was also responsible for coining the term psychosurgery. The procedure involved drilling holes in the patient's head and destroying tissue in the frontal lobes by injecting alcohol. He later changed technique, using a surgical instrument called a
leucotomeA leucotome or McKenzie Leucotome is a surgical instrument used for performing leucotomies, lobotomies and other forms of psychosurgery.Invented by Canadian neurosurgeon Dr. Kenneth G...
that cut brain tissue by rotating a retractable wire loop (a quite different cutting instrument also used for lobotomies shares the same name). Between November 1935 and February 1936 Moniz and Lima operated on twenty patients, publishing their findings in the same year. Their own assessment was that 35% of the patients improved greatly, 35% improved moderately and that in the remaining 30% there was no change. The patients were aged between 27 and 62 years of age, twelve were female and eight were male. Nine of the patients were diagnosed as suffering from depression, six from
schizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
, two from
panic disorderPanic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
, and one each from
maniaMania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...
,
catatoniaCatatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
and manic-depression with the most prominent symptoms being anxiety and agitation. The duration of the illness prior to the procedure varied from as little as four weeks to as much as 22 years, although all but four had been ill for at least one year. The post-operative follow-up assessment took place anywhere from one to ten weeks following surgery. The observed complications were less severe than in Burckhardt's sample as there were no deaths or epileptic convulsions and the most cited complication was fever.
The theoretical underpinnings of Moniz's
avant garde psychosurgery were largely commensurate with the nineteenth century ones that formed the basis of Burckhardt's theories before him. Although in his later writings he referenced both the neuron theory of Ramón y Cajal and the conditioned reflex of
Ivan PavlovIvan Petrovich Pavlov was a famous Russian physiologist. Although he made significant contributions to psychology, he was not in fact a psychologist himself but was a mathematician and actually had strong distaste for the field....
, in essence he simply interpreted this new neurological research in terms of the old psychological theory of
associationismAssociationism in philosophy refers to the idea that mental processes operate by the association of one state with its successor states.The idea is first recorded in Plato and Aristotle, especially with regard to the succession of memories....
. He differed significantly from Burckhardt in that he did not think there was any physical anatomical pathology in the brains of the mentally ill, but rather that their neural pathways were caught in fixed and destructive circuits As he wrote in 1936:
[The] mental troubles must have [...] a relation with the formation of cellulo-connective groupings, which become more or less fixed. The cellular bodies may remain altogether normal, their cylinders will not have any anatomical alterations; but their multiple liaisons, very variable in normal people, may have arrangements more or less fixed, which will have a relation with persistent ideas and deliria in certain morbid psychic states.
The removal of these aberrant and fixed pathological brain circuits, therefore, might lead to some improvement in mental symptoms. Moniz believed that the brain would functionally adapt to such injury. A significant advantage of this approach was that, unlike the position adopted by Burckhardt, it was unfalsifiable according to the knowledge and technology of the time as the absence of a known correlation between physical brain pathology and mental illness could not disprove his thesis.
Traditionally, the question of why Moniz targeted the frontal lobes in particular has been answered by reference to a presentation by
John FultonJohn Fulton may refer to:* John P. Fulton , American special effects supervisor and cinematographer* John Fulton , American author* John H...
and Carlyle Jacobsen at the Second International Congress of Neurology held in London in 1935. Fulton and Carlyle presented two
chimpanzeeChimpanzee, sometimes colloquially chimp, is the common name for the two extant species of ape in the genus Pan. The Congo River forms the boundary between the native habitat of the two species:...
s who had undergone frontal lobectomies. The operation had had a pacifying effect on the two primates, who had previously suffered from behavioral disorders. It has been alleged that this provided the impetus and inspiration for Moniz to try the same technique on psychiatric patients. However, as Berrios points out, this conflicts with the fact that Moniz had told his colleague Lima in confidence as early as 1933 of his psychosurgical idea. Nor did he mention Fulton's and Carlyle's presentation as an influence when writing about the procedure in 1936. Indeed, as Kotowicz notes, his attention was drawn more to the case presented by Richard Brickner, at the same conference, of a patient who had had his frontal lobes ablated and, while experiencing a flattening of affect, had suffered no apparent decrease in intellect. Brickner had published on this case in 1932.
Moniz was given the
Nobel Prize for medicineThe Nobel Prize in Physiology or Medicine administered by the Nobel Foundation, is awarded once a year for outstanding discoveries in the field of life science and medicine. It is one of five Nobel Prizes established in 1895 by Swedish chemist Alfred Nobel, the inventor of dynamite, in his will...
in 1949 for this work.
Walter Freeman
The American
neurologistA neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
and psychiatrist Walter Freeman, who had also attended the London Congress of Neurology in 1935, was intrigued by Moniz's work, and with the help of his close friend, neurosurgeon
James W. WattsJames Winston Watts was a neurosurgeon, born in Lynchburg, Virginia and a graduate of the Virginia Military Institute and the University of Virginia School of Medicine. Watts is noteworthy for his professional partnership with the neurologist and psychiatrist Walter Freeman...
, he performed the first prefrontal leucotomy in the United States in 1936 at the hospital of George Washington University in Washington. Freeman and Watts gradually refined the surgical technique and created the Freeman-Watts procedure (the "precision method", the standard prefrontal lobotomy).
The Freeman-Watts prefrontal lobotomy still required drilling holes in the scalp, so surgery had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed this surgery would be unavailable to those he saw as needing it most: patients in state mental hospitals that had no operating rooms, surgeons, or
anesthesiaAnesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
and limited budgets. Freeman wanted to simplify the procedure so that it could be carried out by psychiatrists in mental asylums, which housed roughly 600,000 American inpatients at the time.
Inspired by the work of Italian psychiatrist
Amarro FiambertiAmarro Fiamberti was an Italian psychiatrist who first performed a transorbital lobotomy in 1937...
, Freeman at some point conceived of approaching the frontal lobes through the eye sockets instead of through drilled holes in the skull. In 1945 he took an
icepickAn ice pick is a tool used to break up, pick at, or chip at ice. It resembles a scratch awl, but is designed for picking at ice rather than wood...
from his own kitchen and began testing the idea on grapefruit and cadavers. This new "transorbital" lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an
orbitoclastAn orbitoclast is a surgical instrument used for performing transorbital lobotomies. It was invented by Dr. Walter Freeman in 1948 to replace the unique form of leucotome used up until that point for the transorbital lobotomy procedure. This instrument is an ice pick with some gradation marks...
or leucotome, although quite different from the wire loop leucotome described above) under the eyelid and against the top of the eyesocket. A mallet was used to drive the orbitoclast through the thin layer of bone and into the brain along the plane of the bridge of the nose, around fifteen degrees toward the interhemispherical fissure. The orbitoclast was mallated five centimetres into the frontal lobes, and then pivoted forty degrees at the orbit perforation so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further two centimetres into the brain, before being pivoted around twenty eight degrees each side, to cut outwards and again inwards (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upwards so the tool cut vertically down the side of the cortex of the interhemispherical fissure; the "Deep frontal cut".) All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side.
Freeman performed the first transorbital lobotomy on a live patient in 1946. Its simplicity suggested the possibility of carrying it out in mental hospitals lacking the surgical facilities required for the earlier, more complex procedure (Freeman suggesting that, where conventional anesthesia was unavailable,
electroconvulsive therapyElectroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
be used to render the patient unconscious). In 1947, the Freeman and Watts partnership ended as the latter was disgusted by Freeman's modification of the lobotomy from a surgical operation into a simple "office" procedure. Between 1940 and 1944, 684 lobotomies were performed in the United States. However, because of the fervent promotion of the technique by Freeman and Watts, those numbers increased sharply towards the end of the decade. In 1949, the peak year for lobotomies in the US, 5,074 procedures were undertaken, and by 1951 over 18,608 individuals had been lobotomised in the US.
Prevalence
Most lobotomy procedures were done in the United States, where approximately 40,000 people were lobotomized. In Great Britain, 17,000 lobotomies were performed, and the three Nordic countries of Finland, Norway and Sweden had a combined figure of approximately 9,300 lobotomies. Scandinavian hospitals lobotomized 2.5 times as many people per capita as hospitals in the US. Sweden lobotomized at least 4,500 people between 1944 and 1966, mainly women. This figure includes young children. In Norway there were 2,500 known lobotomies. In Denmark there were 4,500 known lobotomies, mainly young women, as well as mentally retarded children.
Indications and outcomes: medical literature
According to the
Psychiatric Dictionary published in 1970:
Prefrontal lobotomy is of value in the following disorders, listed in a descending scale of good results: affective disorders, obsessive-compulsive states, chronic anxiety states and other non-schizophrenic conditions, paranoid schizophrenia, undetermined or mixed type of schizophrenia, catatonic schizophrenia, and hebephrenic and simple schizophrenia. Good results are obtained in about 40 percent of cases, fair results in some 35 percent and poor results in 25 percent are
thereabouts. The mortality rate probably does not exceed 3 percent. Greatest improvement is seen in patients whose premorbid personalities were 'normal', cyclothymic, or obsessive compulsive; in patients with superior intelligence and good education; in psychoses with sudden onset and a clinical picture of affective symptoms of depression or anxiety, and with behaviouristic changes such as refusal of food, overactivity, and delusional ideas of a paranoid nature.
Prefrontal lobotomy has also been used successfully to control pain secondary to organic lesions. In this case, the tendency has been to employ unilateral lobotomy, because of the evidence that a lobotomy extensive enough to reduce psychotic symptoms is not required to control pain.
According to the same source, prefrontal lobotomy reduces:
anxiety feelings and introspective activities; and feelings of inadequacy and self-consciousness are thereby lessened. Lobotomy reduces the emotional tension associated with hallucinations and does away with the catatonic state. Because nearly all psychosurgical procedures have undesirable side effects, they are ordinarily resorted to only after all other methods have failed. The less disorganized the personality of the patient, the more obvious are post-operative side effects. ...
Convulsive seizures are reported as sequelae of prefrontal lobotomy in 5 to 10 percent of all cases. Such seizures are ordinarily well controlled with the usual anti-convulsive drugs. Post-operative blunting of the personality, apathy, and irresponsibility are the rule rather than the exception. Other side effects include distractibility, childishness, facetiousness, lack of tact or discipline, and post-operative incontinence.
Criticism
As early as 1944 an author in the
Journal of Nervous and Mental Disease remarked: "The history of prefrontal lobotomy has been brief and stormy. Its course has been dotted with both violent opposition and with slavish, unquestioning acceptance." Beginning in 1947 Swedish psychiatrist Snorre Wohlfahrt evaluated early trials, reporting that it is "distinctly hazardous to leucotomize schizophrenics" and lobotomy to be "still too imperfect to enable us, with its aid, to venture on a general offensive against chronic cases of mental disorder" and stating that "Psychosurgery has as yet failed to discover its precise indications and contraindications and the methods must unfortunately still be regarded as rather crude and hazardous in many respects." In 1948
Norbert WienerNorbert Wiener was an American mathematician.A famous child prodigy, Wiener later became an early researcher in stochastic and noise processes, contributing work relevant to electronic engineering, electronic communication, and control systems.Wiener is regarded as the originator of cybernetics, a...
, the author of
Cybernetics: Or the Control and Communication in the Animal and the Machine, said: "[P]refrontal lobotomy... has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier."
Concerns about lobotomy steadily grew. The USSR officially banned the procedure in 1950. Doctors in the Soviet Union concluded that the procedure was "contrary to the principles of humanity" and that it turned "an insane person into an idiot." By the 1970s, numerous countries had banned the procedure as had several US states. Other forms of psychosurgery continued to be legally practiced in controlled and regulated US centers and in Finland, Sweden, the UK, Spain, India, Belgium and the Netherlands.
In 1977 the US Congress created the National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery—including lobotomy techniques—were used to control minorities and restrain individual rights. It also investigated the after-effects of surgery. The committee concluded that some extremely limited and properly performed psychosurgery could have positive effects.
By the early 1970s the practice of lobotomy had generally ceased, but some countries continued to use other forms of
psychosurgeryPsychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...
. In 2001 there were, for example, 70 operations in Belgium, about 15 in the UK and about 15 a year at Massachusetts General Hospital in Boston, while France had carried out operations on about 5 patients a year in the early 1980s.
Notable cases
- Rosemary Kennedy
Rose Marie "Rosemary" Kennedy was the third child and first daughter of Rose Elizabeth Kennedy née Fitzgerald and Joseph Patrick Kennedy, Sr., born little more than a year after her brother, future U.S. President John F. Kennedy...
, sister of President John F. Kennedy, underwent a lobotomy in 1941 at age 23 which left her permanently incapacitated.
- Howard Dully
Howard Dully is one of the youngest recipients of the transorbital lobotomy, a procedure performed on him when he was 12 years old. Dully received international attention in 2005, following the broadcasting of his story on National Public Radio...
wrote a memoir of his late-life discovery that he had been lobotomized in 1960 at age 12.
- New Zealand author and poet Janet Frame
Janet Paterson Frame, ONZ, CBE was a New Zealand author. She wrote eleven novels, four collections of short stories, a book of poetry, an edition of juvenile fiction, and three volumes of autobiography during her lifetime. Since her death, a twelfth novel, a second volume of poetry, and a handful...
received a literary award in 1951 the day before a scheduled lobotomy was to take place, and it was never performed.
- French Canadian singer Alys Robi underwent a lobotomy and later resumed singing professionally.
- Swedish modernist painter Sigrid Hjertén
Sigrid Hjertén , was a Swedish modernist painter. Hjertén is considered a major figure in Swedish modernism. Periodically she was highly productive and she participated in 106 exhibitions...
died following a lobotomy in 1948.
- Playwright Tennessee Williams
Thomas Lanier "Tennessee" Williams III was an American writer who worked principally as a playwright in the American theater. He also wrote short stories, novels, poetry, essays, screenplays and a volume of memoirs...
's older sister Rose received a lobotomy which left her incapacitated for life; the episode is said to have inspired characters and motifs in certain of his works.
It is often said that when an iron rod was accidentally driven through the head of
Phineas GagePhineas P. Gage was an American railroad construction foreman now remembered for his improbablesurvival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain's left frontal lobe, and for that injury's reported effects on his personality and...
in 1848, this constituted an "accidental lobotomy", or that this event somehow inspired the development of surgical lobotomy a century later. According to the only book-length study of Gage, careful inquiry turns up no such link.
Literary and cinematic portrayals
Lobotomies have been featured in several literary and cinematic presentations that both reflected society's attitude towards the procedure and, at times, changed it. The 1946 novel
All the King's MenAll the King's Men is a novel by Robert Penn Warren first published in 1946. Its title is drawn from the nursery rhyme Humpty Dumpty. In 1947 Warren won the Pulitzer Prize for All the King's Men....
by
Robert Penn WarrenRobert Penn Warren was an American poet, novelist, and literary critic and was one of the founders of New Criticism. He was also a charter member of the Fellowship of Southern Writers. He founded the influential literary journal The Southern Review with Cleanth Brooks in 1935...
described a lobotomy, saying it "would have made a Comanche brave look like a tyro [novice] with a scalping knife." The surgeon is portrayed as a repressed man who couldn't change others with love but instead resorted to "high-grade carpentry work." In
Tennessee WilliamsThomas Lanier "Tennessee" Williams III was an American writer who worked principally as a playwright in the American theater. He also wrote short stories, novels, poetry, essays, screenplays and a volume of memoirs...
's 1958 play,
Suddenly, Last SummerSuddenly, Last Summer is a one-act play by Tennessee Williams. It opened off Broadway on January 7, 1958, as part of a double bill with another of Williams's one-acts, Something Unspoken. The presentation of the two plays was given the overall title Garden District, but Suddenly, Last Summer is...
, the protagonist is threatened with a lobotomy to stop her from telling the truth about her cousin Sebastian. The surgeon says, "I can't guarantee that a lobotomy would stop her
babbling." Her aunt responds, "That may be, maybe not, but after the operation who would
believe her, Doctor?"
A damning portrayal of the procedure is found in
Ken KeseyKenneth Elton "Ken" Kesey was an American author, best known for his novel One Flew Over the Cuckoo's Nest , and as a counter-cultural figure who considered himself a link between the Beat Generation of the 1950s and the hippies of the 1960s. "I was too young to be a beatnik, and too old to be a...
's 1962 novel
One Flew Over the Cuckoo's NestOne Flew Over the Cuckoo's Nest is a novel written by Ken Kesey. Set in an Oregon asylum, the narrative serves as a study of the institutional process and the human mind, as well as a critique of Behaviorism and a celebration of humanistic principles. Written in 1959, the novel was adapted into a...
and its
1975 movie adaptationOne Flew Over the Cuckoo's Nest is a 1975 American drama film directed by Miloš Forman and based on the 1962 novel of the same name by Ken Kesey....
. Several patients in the mental ward receive lobotomies in order to discipline or calm them. The operation is described as brutal and abusive, a "frontal-lobe castration". The book's narrator, Chief Bromden, is shocked: "There's nothin' in the face. Just like one of those store dummies." One patient's surgery changes him from an acute to a chronic mental condition. "You can see by his eyes how they burned him out over there; his eyes are all smoked up and gray and deserted inside."
Other sources include
Sylvia PlathSylvia Plath was an American poet, novelist and short story writer. Born in Massachusetts, she studied at Smith College and Newnham College, Cambridge before receiving acclaim as a professional poet and writer...
's 1963 novel
The Bell JarThe Bell Jar is American writer and poet Sylvia Plath's only novel, which was originally published under the pseudonym "Victoria Lucas" in 1963. The novel is semi-autobiographical with the names of places and people changed...
, in which the protagonist, Esther, reacts with horror to the "perpetual marble calm" of a lobotomized young woman named Valerie.
Elliott BakerElliott Baker , born Elliot Joseph Cohen, was a screenwriter and novelist.Baker was born in Buffalo, New York, and graduated from Indiana University. He was the author of the comic novel A Fine Madness, which was published in 1964 by G.P. Putnam's Sons...
's 1964 novel and 1966 film version,
A Fine MadnessA Fine Madness is a motion picture comedy based on the 1964 novel by Elliott Baker that tells the story of Samson Shillitoe, a frustrated poet unable to finish a grand tome. It stars Sean Connery , Joanne Woodward, Jean Seberg, Patrick O'Neal and Clive Revill...
, portrays the dehumanizing lobotomy of a womanizing, quarrelsome poet who in the end is just as aggressive as ever. The surgeon is depicted as an inhumane crackpot. In the 1968 film
Planet of the ApesPlanet of the Apes is a 1968 American science fiction film directed by Franklin J. Schaffner, based on the 1963 French novel La Planète des singes by Pierre Boulle. The film stars Charlton Heston, Roddy McDowall, Kim Hunter, Maurice Evans, James Whitmore, James Daly and Linda Harrison...
, time travelling astronaut Landon (Robert Gunner) is subjected to a lobotomy by Dr. Zaius (
Maurice EvansMaurice Evans may refer to:*Maurice Evans , Oswestry Town and Wales international footballer*Maurice Evans , English actor*Maurice Evans , British football player and manager...
) and rendered catatonic in an effort to shield the truth from the Ape race by covering up the fact that man was once an intelligent being capable of speech. The 1982 biopic
FrancesFrances is a 1982 American drama film starring Jessica Lange, Kim Stanley, and Sam Shepard. When it was released this film was advertised as a purportedly true account of actress Frances Farmer's life but the script was largely fictional and sensationalized...
includes a disturbing scene showing actress
Frances FarmerFrances Elena Farmer was an American actress of stage and screen. She is perhaps better known for sensationalized and fictional accounts of her life, and especially her involuntary commitment to a mental hospital...
undergoing transorbital lobotomy. The claim that a lobotomy was performed on Farmer (and that Freeman performed it) has been criticized as having little or no evidence supporting it.
In
Unruhe"Unruhe" is a 1996 episode of The X-Files television series. It was the fourth episode broadcast in the show's fourth season, and the first episode to air on Sunday night when the show was moved from Fridays to Sundays. "Unruhe" features a man who kidnaps women and lobotomizes them...
, an episode in the fourth season of
The X-FilesThe X-Files is an American science fiction television series and a part of The X-Files franchise, created by screenwriter Chris Carter. The program originally aired from to . The show was a hit for the Fox network, and its characters and slogans became popular culture touchstones in the 1990s...
, a kidnap victim is discovered wandering aimlessly along a road, staring blankly ahead and not responding to any of her surroundings. She is hospitalized and a PET scan reveals that a transorbital lobotomy, done incorrectly, has been performed on her. It is performed on another woman and Scully herself narrowly escapes the procedure.
In the 2011 movie
Sucker PunchSucker Punch is a 2011 action-fantasy thriller film, directed by Zack Snyder and co-written by him and Steve Shibuya. It is Snyder's first film based on an original script. The film stars Emily Browning, Abbie Cornish, Jena Malone, Vanessa Hudgens, Jamie Chung, and Oscar Isaac...
, Babydoll's impending lobotomy is what drives her to try and escape from the Institute . An ice-pick type
leucotomeA leucotome or McKenzie Leucotome is a surgical instrument used for performing leucotomies, lobotomies and other forms of psychosurgery.Invented by Canadian neurosurgeon Dr. Kenneth G...
forms part of the detail around the "S" of the films title, counterpoised by the final upright of the "H" being a Samurai sword.
In [The Simpsons] 2F03, Treehouse of Horror V. Moe is subjected to a full frontal lobotomy after undergoing 'Re-neducation' leaving him drooling and somewhat incapacitated. He keeps the removed piece of brain in a jar.
See also
- Bioethics
Bioethics is the study of controversial ethics brought about by advances in biology and medicine. Bioethicists are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine, politics, law, and philosophy....
and Medical ethicsMedical ethics is a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy, theology, and sociology.-History:Historically,...
- Frontal lobe disorder
Frontal lobe disorder is an impairment of the frontal lobe that occurs as a result of a number of diseases as well as head trauma. The frontal lobe of the brain plays a key role in higher mental functions such as motivation, planning, social behaviour, and speech production...
- Frontal lobe injury
Frontal lobe injury is caused by a number of conditions such as trauma, meningitis, or even hypoxia , such as in drowning. The frontal lobe is an extremely vulnerable spot to injury due to its location at the front of the brain, and even minor trauma, such as a concussion, can cause permanent,...
- Psychosurgery
Psychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...
- History of psychosurgery in the United Kingdom
Psychosurgery is a surgical operation that destroys brain tissue in order to alleviate the symptoms of mental disorder. The lesions are usually, but not always, made in the frontal lobes...
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